One of the harder parts of being a health care professional is caring for patients that are suffering from a terminal illness. In those instances, the patient may be referred to a hospice program.
It is important to know the rules that dictate whether a patient is eligible to receive Medicare payments for their hospice care. Failing to adhere to these regulations could leave health care professionals vulnerable to charges of hospice fraud.
In January, a Mississippi doctor pleaded guilty to one count of conspiracy to commit health care fraud. He was found to have referred patients that were not eligible for hospice care under Medicare rules.
The doctor was found to have to have certified that these patients were terminally ill even though they were not. His sentence includes 39 months in federal prison and an order to pay Medicare more than $1.9 million in restitution.
Two indicators of hospice fraud
The biggest factor when determining whether hospice is appropriate for a patient is if they are terminally ill. A terminal illness is considered anytime a patient receives a prognosis of life expectancy that is six months or less.
One frequent sign of fraud is if a large number of patients are being discharged from a hospice program. If a patient is discharged from the program, they may have been mistakenly labeled as being terminally ill. If there are an abnormally large number of live discharges, it may prompt authorities to investigate whether there is fraudulent activity.
Kickbacks are another factor that can lead to charges of hospice fraud. The Office of Inspector General (OIG) defines a kickback as receiving “anything of value” in exchange for a referral of services. While payment for referrals is an accepted business practice in some industries, it is illegal to do so when it comes to services related to Medicare and Medicaid.
Understanding these two common sources of hospice fraud can help you ensure your practice is following the rules of these health care programs. If you do end up facing charges of health care fraud, consulting with an experienced attorney may help you be better positioned to defend against the allegations.